It's not the same thing.  If you had a air line with 100psi in it and
placed a balloon (capable of withstanding 5psi) over the end and
then opened a valve, the balloon would burst.  If you only opened
the valve a little (regulated the flow) the balloon would still
burst.  If you installed a pressure regulator and set it at 1psi
and opened the valve either part way or fully open the balloon
would inflate and not burst.  There is a major difference between
regulating flow and pressure.

The Cochrane Review has reviewed nasal saliine, and found it
effective: know that they often have some flawed conclusions, usually
they exclude so many studies as poor quality that they have no
conclusion, but they were pretty clear here. Notice that one study
showed no additional benefit from steroids over saline. I'll read the
long version soon.
Dear Clinician,

Here is the information you requested (sourced from Reuters Health).

Nasal saline irrigations relieve chronic rhinosinusitis

By Will Boggs, MD

Nasal saline irrigation improves symptoms in patients with chronic
rhinosinusitis, according to a report in the July 18th issue of the
Cochrane Database of Systematic Reviews.

"Saline irrigations are not just a 'feel good' treatment," Dr. Richard
Harvey, currently at the Medical University of South Carolina,
Charleston, told Reuters Health. "In chronic sino-nasal disease, the
use of topical nasal saline, while not more effective than
prescription medications, improves clinical outcomes and can be
included in the treatment plan."

Dr. Harvey and associates assessed the published evidence for the
clinical effectiveness of topical saline therapy in the management of
the symptoms of chronic rhinosinusitis.

Saline irrigation was better than no treatment for improving symptoms
and disease-specific quality-of-life scores in three studies that
investigated this treatment, the authors report, and saline improved
disease-specific quality-of-life as an addition to oral antihistamine
therapy in one study.

In contrast, saline did not improve disease-specific quality-of-life
scores over a reflexology control or over intra-nasal steroid in two
studies.

In the two studies that compared isotonic with hypertonic saline,
there was no difference in benefit between the two concentrations.

"We currently have several studies focused on the efficacy of
different delivery techniques (there are numerous varieties on the
market - pump sprays, pressurized sprays, squeeze bottles, Neti pots
and nebulizers)," Dr. Harvey said.

"Some of the most frequently asked questions involve the optimal
delivery technique, volume, and frequency for using nasal saline," he
added. "While this is an area of ongoing research, my clinical
judgment and experience from working with world leaders in nose and
sinus care suggests that squeeze bottles ... and pressurized sprays
which can deliver high volumes under positive pressure are probably
the most effective."

Cochrane Database Syst Rev 2007;3. [<http://imageb.epocrates.com/
mailbot/links?EdID=34565843&LinkID=11935>Cochrane review]

You can call it what you want.  I don't think it's necessarily a
common sense issue.  To me it's very hard to tell if I am forcing
fluid to my ears or not.

...and then it's too late.

You can prevent solution into the ear by
A. Never tilt your head to the side when irrigating. When you tilt to the
side - say to the left, the eustachian tube opening lies lowest and solution
pools there. If you have a patent open tube then the solution will enter.

B Don't swallow or blow while irrigating. This raises the pressure and can
force the solution into the ear.

C. Keep the pressure at 5 PSI. It takes 10 PSI to get fluid into the
eustachian tube, so keep the stream from the Hydro Pulse at almost one inch
high, and similarly whatever method you are using.

D after irrigation do not blow your nose except very very gently.
E When you lean well into the sink, like a low bow, your eustachian opening
is at the highest point and is barely reached by the irrigation solution.

Murray Grossan, M.D.